Numerous instances of breast cancer might be averted with additional mastectomies, a recent study hints
Expanding Breast Cancer Prevention: A New Approach
A groundbreaking study, published in the esteemed journal JAMA Oncology, is set to change the landscape of breast cancer prevention. The study suggests that women carrying certain moderate-risk genes, as well as those with high-risk factors, could potentially be candidates for risk-reducing mastectomies (RRMs).
The study recommends expanding the eligibility criteria for RRMs beyond women with BRCA1, BRCA2, and PALB2 mutations. Women with a lifetime breast cancer risk of 35% or higher, regardless of genetic mutation status, could now be offered RRMs. This expanded eligibility is supported by recent economic evaluations, which suggest that the overall breast cancer risk should be the primary consideration, rather than high-penetrance genes alone.
In addition to the traditional high-risk genes, women carrying genes such as ATM, CHEK2, RAD51C, and RAD51D may also be candidates for RRMs. However, it's important to note that non-genetic factors should also be considered when assessing risk. These factors include family history of breast cancer, parity (number of children), breastfeeding history, and mammographic breast density.
Combinations of these clinical and genetic risk factors can result in a lifetime breast cancer risk exceeding the 35% threshold, making women eligible for RRM. This approach supports personalized breast cancer prevention, expanding beyond traditional high-risk genetic mutations while emphasizing comprehensive risk assessment.
The study indicates that offering RRM at this risk threshold is cost-effective compared to nonsurgical prevention methods, such as screening and medications like tamoxifen or anastrozole, in women aged 30-55 years. This cost-effectiveness has been demonstrated in modeling studies in the UK. Expanding RRM eligibility could prevent thousands of breast cancer cases annually while providing value for healthcare systems.
However, decisions about RRM remain complex and deeply personal. Women should be supported with counseling on all available risk management options, including surveillance and medicinal prevention. It's vital that women can consider all their options, including screening and risk-reducing medications.
Louise Grimsdell, Breast Cancer Now senior clinical nurse specialist, emphasized that women should consider all options, not just surgery. The study also recommends more research to evaluate the acceptability, uptake, and long-term outcomes of RRM among this group.
The unacceptably long waits for women who choose risk-reducing surgery need to be urgently tackled. Professor Ranjit Manchanda, professor of gynaecological oncology at Queen Mary, stated this. If all women aged 30 to 55 with a risk of 35% or more could be identified, and they all then had RRM, an estimated 6,538 cases could be prevented each year.
In conclusion, this approach to breast cancer prevention supports personalized care, expanding beyond traditional high-risk genetic mutations while emphasizing comprehensive risk assessment. Women should be supported by their clinicians to make informed decisions that are right for them.
- This expanded approach to breast cancer prevention, as suggested by the study, considers women with a lifetime breast cancer risk of 35% or higher, regardless of their genetic mutation status, as potential candidates for risk-reducing mastectomies.
- Apart from the traditional high-risk genes like BRCA1, BRCA2, and PALB2, genes such as ATM, CHEK2, RAD51C, and RAD51D may also make women candidates for risk-reducing mastectomies.
- The study suggests that more research is needed to evaluate the acceptability, uptake, and long-term outcomes of risk-reducing mastectomies among women who fall into this expanded eligibility category.
